Action Points

Unintentional and intentional firearm homicides fell, while the rate of firearm suicides increased dramatically, among children ages 0 to 17 years, according to a retrospective analysis of large databases from 2007 to 2014.

Note that limitations to the data include possible significant underreporting of unintentional firearm deaths, potential misclassification bias among certain racial and ethnic groups in death certificate data, and the data not being nationally representative.

The number of children being killed by guns is down, but the number of children intentionally killing themselves with guns is up, a retrospective analysis of several large databases found.

Both unintentional and intentional firearm homicides among children ages 0 to 17 years fell from 2007 to 2014, while the rate of firearm suicides among this population increased dramatically from 2007 to 2014, reported Katherine A. Fowler, PhD, of the CDC, and colleagues.

The authors found that African-American children had the highest rate of firearm mortality (4.1 per 100,000), with an annual firearm homicide rate approximately 10 times higher than the rate for white children and Asian American children from 2012 to 2014 (3.5 versus 0.4 per 100,000 each, respectively).

Similar patterns were observed for the rates of unintentional firearm deaths, with the rate of death for African-American children twice as high as the rate for white children (0.2 versus 0.1 per 100,000), but the authors noted that rates of unintentional firearm deaths were between 0.1 and 0.2 per 100,000 "across racial and ethnic groups."

But suicide rates show different demographic trends. White and American Indian children had the highest annual average rate of firearm suicide from 2012 to 2014 (each 2.2 per 100,000) -- over five times higher than the rate for Asian American children (0.4 per 100,000).

Writing in Pediatrics, the authors described their work as "the most comprehensive analysis of firearm-related deaths and injuries among US children to date." Other studies only analyzed "selected outcomes" or certain types of injuries.

An accompanying editorial by Eliot W. Nelson, MD, of University of Vermont Children's Hospital, characterized the study as bringing "deeper insight into the circumstances and factors involved with these deaths" than prior studies. He noted "persistently high suicide rates" in some rural states, and that other research showed "youth firearm suicide to predominate in rural counties nationwide."

Overall, 1,300 children died (1.8 per 100,000), which was comprised of 53% homicides and 38% suicides. Interestingly, younger children were three times more likely to be killed by a gun in a homicide (0.3 per 100,000) than to die from an unintentional gunshot wound.

There were 5,790 children injured by gunshot wounds per year who received treatment in an emergency department (7.9 per 100,000). These injuries were either from a firearm-related assault, an act of self-harm, or from unintentional injury.

The number of child firearm homicides was up significantly from 2002 to 2007 (+17%, annual percent change=4.6, P<0.05), but then posted a significant decline from 2007 to 2014 (-36%, annual percent change= -6.7, P<0.05).

Conversely, the number of child suicides fell from 2002 to 2007 (-23%, annual percent change= -4.2, P<0.05), but then increased 60% from 2007 to 2014 (annual percent change=6.3, P<0.05).

However, older children (ages 13-17 years) had a firearm injury rate more than 12 times higher than the rate for children ages 0 to 12 years (5.1 versus 0.4 per 100,000, respectively).

Limitations to the data include that unintentional firearm deaths may be "significantly underreported," as well as potential misclassification bias among certain racial and ethnic groups in death certificate data and that the data is not nationally representative, but based on states with National Violent Death Reporting System funding from 2003 to 2013.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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